Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA.
CardioVascular Center for Research and Innovation, Tufts Medical Center, Boston, MA, USA.
J Cardiovasc Transl Res. 2021 Jun;14(3):467-475. doi: 10.1007/s12265-020-10068-7. Epub 2020 Aug 28.
We conducted a meta-analysis of preclinical studies that tested left ventricular assist device (LVAD) therapy for reducing myocardial infarct size in experimental acute myocardial infarction (AMI). Twenty-six articles were included with a total of 488 experimental animal subjects. The meta-analysis showed that infarct size was significantly decreased by LVAD support compared to control animals (SDM, - 2.19; 95% CI, - 2.70 to - 1.69; P < 0.001). The meta-regression analysis demonstrated a high degree of heterogeneity associated with time from coronary artery occlusion to LVAD support, which correlated positively with infarct size. Subgroup analysis suggested smaller infarct size in LVAD therapies that withdrew blood from left heart than those from right heart. The proportion of left ventricular support relative to total cardiac output was positively correlated with infarct size reduction in Impella studies. Thus, early initiation of LVAD after ischemia and effective left ventricular venting may be important factors to reduce infarct size in AMI.
我们对测试左心室辅助装置（LVAD）治疗缩小实验性急性心肌梗死（AMI）心肌梗死面积的临床前研究进行了荟萃分析。共纳入 26 篇文章，总计 488 只实验动物。荟萃分析显示，与对照组动物相比，LVAD 支持显著降低了梗死面积（SMD，-2.19；95%CI，-2.70 至-1.69；P<0.001）。Meta 回归分析显示，与 LVAD 支持至冠状动脉阻塞之间的时间相关的异质性程度较高，与梗死面积呈正相关。亚组分析表明，从左心抽取血液的 LVAD 疗法比从右心抽取血液的疗法的梗死面积更小。Impella 研究中，与全心输出量相比，左心室支持的比例与梗死面积减少呈正相关。因此，缺血后早期启动 LVAD 并有效进行左心室通风可能是减少 AMI 梗死面积的重要因素。
